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Biomedical subjects

A J Scheen

Publications and source records attributed to A J Scheen.

At least 127 records · Page 7Linked to original sources
PubMed2001

[The insulin sensitivity concept].

Insulin resistance was already suspected in the thirties from clinical observations in diabetic patients, then better appreciated in the early sixties with the development of insulin radioimmunoassay, and finally confirmed in the last 20 years by using various sophisticated methods able to quantify insulin action. First demonstrated in obese and/or type 2 diabetic patients, the diminution of insulin sensitivity may in fact concern a much larger population. The concept of insulin sensitivity gained a considerable importance when Reaven, in 1988, emphasized the role of insulin resistance in different human diseases. The metabolic syndrome or syndrome X is characterized by the association of various cardiovascular risk factors (among which impaired glucose tolerance, arterial hypertension and dyslipidaemias), all closely linked to insulin resistance which is indeed the core of the syndrome. Even if insulin action signalling appears to be rather complex and the mechanisms leading to insulin resistance still largely unknown, it is essential to develop pharmacological or non pharmacological strategies to improve insulin sensitivity for treating insulin-resistant individuals. Such an approach should allow not only to provide a better blood glucose control in patients with type 2 diabetes, but also to improve the cardiovascular prognosis of numerous patients, with or without diabetes mellitus, who have the metabolic syndrome.

Cardiovascular Diseases↗
PubMed2001

[Muscular exercise in the diabetic patient].

Muscular exercise is recommended in patients with type 1 or type 2 diabetes mellitus and is part of the overall management, in combination with diet, oral antidiabetic agents and/or insulin. From a pathophysiological point of view, regular physical activity enhances insulin sensitivity, thus contributing to improve blood glucose control and to reduce cardiovascular risk factors associated to diabetes mellitus. From a practical point of view, however, muscular exercise in a diabetic patient requires special caution, in particular careful selection of the type of exercise, respect of metabolic and/or cardiovascular contraindications, and appropriate adjustment of current pharmacological/dietary treatment.

Blood Glucose↗
PubMed2001

[Guidelines for good practice of sports activities].

The present closing article summarizes some guidelines for the good practice of physical activities in order to develop and maintain cardiorespiratory and muscular fitness, and flexibility. Advice is given regarding the recommended quantity and quality of exercise in term of intensity, duration and frequency of training with the aim to optimize the risk/benefit ratio for health, in both aerobic endurance and resistance exercises. The crucial role of an appropriate warm-up and cool-down period, which would include flexibility exercises, is also emphasized. Finally, some practical examples illustrate this vademecum of physical activities.

Exercise↗
PubMed2001

[Pharma-clinics. Medication of the month. Repaglinide (NovoNorm)].

Repaglinide (NovoNorm) is an antidiabetic oral agent of the new glinide class with insulinotropic activity. Its action on insulin secretion is more rapid and shorter than that of sulphonylurea compounds. Thanks to these properties, repaglinide is able to better control postprandial hyperglycaemia and is associated with a lower risk of delayed hypoglycaemic episodes. It is indicated for the treatment of type 2 (non-insulin-dependent) diabetes mellitus as monotherapy, after diet failure, or in combination with metformin, when the biguanide is insufficient. NovoNorm is commercialized as tablets of 0.5, 1 and 2 mg, to be taken just before each meal. Initial dosis should be 0.5 mg before meal in diabetic patients on diet alone or 1 mg before meal in patients already receiving an hypoglycaemic agent. If necessary, the dosis should be progressively increased, depending on the individual response, up to 4 mg before meal (maximal daily dosage of 16 mg), in order to optimize blood glucose control.

Administration, Oral↗
PubMed2001

[Clinical study of the month. Prevention of type 2 diabetes in overweight patients with impaired glucose tolerance: efficiency of lifestyle changes].

The "Finnish Diabetes Prevention Study" is a prospective controlled study recently published in the New England Journal of Medicine which compared the risk of developing type 2 diabetes among 265 high-risk patients treated by changes in lifestyle to that of 257 matched controlled patients. This intervention trial demonstrated that the risk of type 2 diabetes could be reduced by 58% (p < 0.001) after a mean follow-up of 3.2 years with changes in lifestyle of high-risk overweight subjects with impaired glucose tolerance.

Adult↗
PubMed2001

[Multidisciplinary management of the obese patient: example from the Obesity Center at the University of Liege].

Obesity is a mulfactorial disease whose prevalence is progressively increasing. Ideally, it requires a multidisciplinary management by medical doctors, dieticians, psychologists and kinetherapists. The new "Centre de l'Obésité" at the University of Liège aims at fulfilling such objectives with: 1) a first outpatient visit including the simultaneous participation of an endocrinologist, a dietician and a psychologist; 2) a structured and individualized programme of physical rehabilitation; 3) an individualized management of obese subjects as in-(hospital) and/or outpatients, using medical and/or surgical approaches; and 4) an opportunity to benefit of other specialized medical advices, if necessary, in order to increase both the efficacy and safety of the treatment. Owing to the increasing importance of obesity and the well-known difficulties to succeed in treating it, general practitioners should consider this new centre as a valuable help rather than a competitive structure for the management of their patients, especially those with severe or morbid obesity.

Counseling↗
PubMed2001

[Info-congress. Insulin therapy for preventing type 1 diabetes in high-risk relatives: negative results of the "Diabetes Prevention Trial-Type 1"].

The results of the American multicentre "Diabetes Prevention Trial-Type 1" were presented by J. Skyler during the last congress of the American Diabetes Association in Philadelphia on June 23, 2001. The prophylactic subcutaneous administration of low-dose insulin was not able to prevent the development of type 1 diabetes nor to preserve residual insulin secretion in young relatives at very high-risk of diabetes (> 50% in the next 5 years), selected upon genetic, immunological and metabolic criteria.

Adolescent↗
PubMed2001

[Finapres, efficient technique in the assessment of orthostatic hypotension, autonomic neuropathy, and vaso-vagal syncope].

Finapres is a device able to continuously and non invasively measure arterial blood pressure by photoplethysmography in the finger. It can be used in various dynamic tests which involve cardiocirculatory adjustments, as a passive posture test ("tilt test") or an active orthostatic test (from squatting to standing position in the so-called squatting test). It represents a valuable help in the diagnosis of orthostatic hypotension (of endogenous or iatrogenic origin), of autonomic neuropathy (secondary to diabetes mellitus or to a neurological disease) or of vasovagal syncope. All these conditions are characterized by a defect of arterial and venous vasoconstriction and by an insufficient reflex tachycardia because of autonomic dysfunction.

Autonomic Nervous System Diseases↗
PubMed2001

[Fatal rhabdomyolysis caused by cerivastatin].

Cerivastatin was recently withdrawn from the market after the report of more than 30 deaths in the United-States among patients receiving a combination of cerivastatin and gemfibrozil, a fibrate which is not anymore on the Belgian market. The cause of death was attributed to severe rhabdomyolysis. Cases were also reported among patients treated by cerivastatin only. Recommendations for better use of lipid-lowering drugs are given in order to optimize the benefit/risk ratio of such treatment.

Humans↗
PubMed2001

[Current therapy 2001].

The most important drugs registered and/or launched in Belgium during the last year in the various disciplines of internal medicine will be briefly described. The main characteristics of each molecule as well as its modalities of appropriate use in clinical practice will be pointed out.

Anti-Bacterial Agents↗
PubMed2001

[How I explore ... the different forms of sugar diabetes: clinical and biological differental diagnosis].

Owing to the increasing prevalence of diabetes mellitus and the various aspects of this disease, we present a practical approach which allows the clinician to more easily differentiate type 1 diabetes, type 2 diabetes and secondary diabetes of pancreatic origin, i.e. the most common forms of diabetes mellitus. Such an approach uses simple diagnostic criteria, based upon both clinical characteristics (family history, personal history, clinical presentation) and biological markers (C-peptide, autoantibodies,...). A right diagnosis should allow to optimize the management of the diabetic patient.

Biomarkers↗
PubMed2001

[Pharma-clinics. Medication of the month. Sibutramine (Reductil)].

Sibutramine (Reductil, Abbott-Knoll, 10 mg and 15 mg) is a new appetite regulator recommended in the treatment of obesity. It is a noradrenaline and 5-hydroxytryptamine reuptake inhibitor which exerts its effects in vivo predominantly via its secondary and primary amine metabolites. Sibutramine is indicated as an adjunctive therapy within a weight management programme in patients with obesity (BMI > or = 30 kg/m2) or in overweight subjects (BMI > or = 27 kg/m2) if other eight-related risk factors are present (dyslipidaemias, diabetes mellitus). In those patients with an inadequate response on initial dose of 10 mg per day (suggested as less than 2 kg weight loss in four weeks), the dose may be increased to 15 mg once daily, providing that sibutramine is well tolerated. Several large-scale randomized clinical trials demonstrated the efficacy of long-term (at least one year) treatment with sibutramine in obese subjects with or without type 2 diabetes. Sibutramine was also shown to help in maintaining long-term weight reduction. Most frequent side-effects are dry mouth and constipation, as well as mild increase in heart rate and arterial blood pressure. The impact of sibutramine on cardiovascular morbidity and mortality of obese nondiabetic and diabetic patients will be studied soon in a large international prospective clinical trial.

Appetite Depressants↗
PubMed2001

[Info-Meeting. Pharmacologic prevention of the progression from impaired glucose tolerance to type 2 diabetes: favorable effects of metformin and acarbose].

We report the positive results of two large prospective studies of pharmacological prevention of type 2 diabetes presented at the EASD Congress in Glasgow, September 12, 2001. In the "Diabetes Prevention Program", metformin (2 x 850 mg/day), a biguanide compound, reduces the progression from impaired glucose tolerance towards type 2 diabetes by 31% (p < 0.001) while in the "STOP-NIDDM trial", acarbose (3 x 100 mg/day), an alpha-glucosidase inhibitor, diminished it by 24% (p < 0.002). These results are, however, less marked than those obtained with lifestyle modifications including better dietary habits and increased physical exercise (-58% versus control group, p < 0.001).

Acarbose↗
PubMed2001

[Pharma-clinics medication of the month. Nebivolol (Nobiten)].

Nebivolol (Nobiten, Menarini) is a new beta-blocker recommended for the management of essential hypertension, at a dose of 5 mg once daily. It is administered as a racemic mixture of equal proportions of d- and l-enantiomers. As a lipophilic agent, it is metabolised in the liver and transformed in several active metabolites, essentially via the CYP 2D6, an isoform of cytochrome P450 characterized by a genetic polymorphism. Nebivolol is highly specific for beta-1 adrenergic receptors; it is devoid of intrinsic sympathomimetic or membrane stabilising activity. Interestingly enough, it appears to have nitric oxide-mediated vasodilatory effects which might explain its favourable haemodynamic profile. Several comparative trials demonstrated an antihypertensive activity that was similar or slightly superior to that observed with various other reference antihypertensive agents. Nebivolol has an additive antihypertensive effect in combination with hydrochlorothiazide. All studies reported that the drug has a good clinical and biological tolerance profile. Therefore, nebivolol may be recommended as an alternative first-line treatment option for the management of patients with mild to moderate essential hypertension.

Antihypertensive Agents↗
PubMed2001

[Clinical study of the month. Secondary prevention of cerebrovascular accident with perindopril: the PROGRESS study].

PROGRESS ("Perindopril pROtection aGainst REcurrent Stroke Study") demonstrated that blood-pressure lowering treatment with perindopril, an angiotensin converting enzyme inhibitor (combined with the diuretic agent indapamide when necessary), reduces the risk of stroke by 28% (95% CI: 17-38, p < 0.0001) among patients with a history of stroke or transient ischaemic attack. This protective effect was observed among both hypertensive and non-hypertensive individuals. It was more marked in the patients receiving combined perindopril + indapamide treatment (-43%; 95% CI 30-54) who were those who showed the greatest reduction in arterial blood pressure (-12/5 mm Hg). According to these observations, the authors concluded that treatment with these two agents should now be considered routinely for patients with a history of stroke or transient ischaemic attack, irrespective of their blood pressure.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2001

[Info-congress. The Cochrane collaboration, a key role in evidence-based medicine].

During the 9th International Cochrane Colloquium (Lyon October 9-13, 2001), around 700 participants discussed about how to make the evidence dissemination process more efficient in order to promote the Evidence-Based Medicine. The best evidence is summarized in systematic reviews of randomised and/or controlled clinical trials within the Cochrane Library which are prepared with a high methodological quality. However, these reviews should be completed to cover all medical domains, be actualized regularly, and, most importantly, be better known and more largely used by physicians in routine practice. All these objectives could not be attained without an official recognition and a financial support by the public health authorities.

Delivery of Health Care↗
PubMed2001

[Clinical case of the month. Natural history of morbid obesity: towards insulin-requiring type 2 diabetes and reversal after bariatric surgery].

Morbid obesity is a crucial risk factor in the development of type 2 diabetes and is often associated with a metabolic syndrome closely linked to insulin resistance. This case report illustrates the natural history of morbid obesity, starting during the adolescence and ending with an extremely severe type 2 diabetes at the age of 40. Numerous attempts of weight loss with various medical approaches failed and diabetes mellitus rapidly became insulin-requiring in a context of extreme insulin resistance. Finally, the patient was submitted to a gastric bypass which resulted in a drastic weight loss over 50 kg during the year following surgery without any significant side-effects or complications. Type 2 diabetes almost disappeared and the classical markers of insulin resistance were markedly improved. This clinical case clearly demonstrates that successful management of obesity with bariatric surgery can reverse severe type 2 diabetes.

Adult↗